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Aviva Life Insurance Company India Limited

Premium Quotation
Version Number: 65
Prepared On : 27/4/2019
Proposed Date of Commencement
:27/4/2019
Proposal Number: Age of the Life Insured :34 Years
Gender : Male
Product Features

1. Name of the Product : Aviva Wealth Builder


2. Unique Identification No. : 122N100V03
3. Premium Paying Frequency : Annual
4. Cover Description and Premium :

Premium Annual *Goods & Services Tax Total Premium Amount


Sum Assured Policy Term
Payment Term Premium Year 1 Year 2 onwards Year 1 Year 2 onwards
1000000 17 10 50,000 2,250 1,125 52,250 51,125

Illustration-Benefits

Policy Annual Guaranteed Guaranteed **Guaranteed Non Guaranteed


Duration Premium Death Maturity Surrender Value Special Surrender
+ Goods & Services Tax Benefit(At Benefit (GSV)(At the Value (SSV) (At
year end) (At year end) end of year ) the end of year)
1 52,250 1,000,000
2 51,125 1,000,000 30,000 60,000
3 51,125 1,000,000 75,000 96,000
4 51,125 1,000,000 100,000 136,000
5 51,125 1,000,000 125,000 185,000
6 51,125 1,000,000 150,000 237,000
7 51,125 1,000,000 192,500 294,000
8 51,125 1,000,000 260,000 360,000
9 51,125 1,000,000 360,000 450,000
10 51,125 1,000,000 450,000 550,000
11 1,000,000 500,000 600,000
12 1,000,000 550,000 650,000
13 1,000,000 600,000 700,000
14 1,000,000 675,000 770,000
15 1,000,000 750,000 850,000
16 1,000,000 825,000 915,000
17 1,000,000 1,000,000 900,000 1,000,000

Note

All the benefits shown in the above table are guaranteed provided all the due premiums are paid except the special surrender values.
Special Surrender Values may change as decided by the company from time to time, subject to prior approval from IRDA.
* Taxes including but not limited to Goods & Services Tax, Cesses as applicable shall also be levied as notified by the Government from
time to time. Tax laws are subject to change.
This quotation does not include any additional premium payable due to underwriting or effect of any applicable taxes on such additional
premium.
The surrender value shall as per the grid below:

**Surrender Value

Frequency Surrender Eligibility


Single Premium A policy can be surrendered any time during the policy term.
Regular Premium A policy can be surrendered after at least two policy years premiums have been paid.

A minimum guaranteed surrender value will be payable, which will be equal to GSV Factor X Premiums paid excluding extra premium and
taxes, if any. Surrender Value payable is greater of the Guaranteed Surrender Value (GSV) and Special Surrender Value (SSV). For further
details please refer product key feature.
For more details on terms and conditions please read sales brochure of this plan carefully before concluding a sale.

I ______________________, having received the information with respect to the above, have understood the above statement before entering
into the contract.

Signature of the Intermediary :


Place: Policyholders’ Signature:
Date: Place:
Date:
>

Aviva Wealth Builder


Important points you must know about this policy
What is Aviva Wealth
Aviva Wealth Builder is a traditional life insurance plan that doubles your premiums at maturity.
Builder?
What is the guarantee under this plan?
This plan offers guaranteed payout equal to double of the sum of premiums paid (excluding taxes and extra
premiums, if any) at the time of maturity, if all due premiums are paid.
You have the option of Premium Payment Term as ‘Single’, 5 or 10 years with corresponding policy terms of 13, 15
What are the Premium Payment and and 17 years respectively.
Policy Term options under this plan? The premium payment frequency allowed is Yearly only.
You have selected the premium payment term of 10 years with policy term of 17 years.
Death Benefit:
Sum Assured will be paid provided all due premiums till date of death are paid and the policy terminates.
What are the benefits under this plan? Maturity Benefit:
Sum Assured (double of the sum of premiums paid excluding taxes and extra premiums, if any) will be paid at
maturity, if all due premiums are paid Please refer Premium Quotation and Illustration for details.
If you stop paying premium before the first two policy years premiums are paid:

    •The policy shall lapse after the expiry of grace period of 30 days without any benefit. 
    •You have two years from the date of first unpaid premium (FUP) to revive the lapsed policy and if not revived
within this period, the policy shall terminate by paying 30% of the regular premium (excluding taxes and extra
premium, if any). In case of death of the life insured during this period, 100% of all the premiums paid (excluding
taxes and extra premium, if any) shall be paid to the nominee.
If you stop paying premium after at least first two policy years premiums are paid:
What happens if I stop paying my
premiums?
    •The policy shall become paid up policy after the expiry of grace period. 
    •You will have two years from the date of first unpaid premium (FUP) to revive the policy and if not revived within
this period, the policy shall continue with reduced benefits i.e. Paid-Up Sum Assured. The paid-up sum assured
would be:
Sum Assured X Number of Premiums Paid ÷ Total number of premiums payable under the policy
In case of death before maturity or survives till maturity, the paid-up sum assured shall be payable in
respect of a paid-up policy.
Please refer to the Key Feature brochure for details.
You do have an option to cash­in (surrender) this policy after two policy years provided at least two years’ premiums
Can I cash in (surrender) the policy have been paid.
during the term of the policy?
Please note that the surrender amount will be less than the amount of premiums paid in most cases.
Please refer to the Key Feature brochure for details.
In case of death of due to suicide within 12 months:
    •From the date of inception of policy, 80% of premiums paid excluding any payment of taxes and extra premiums,
What is not covered under this policy
(Exclusions)? if any will be paid, provided policy is in force.
    •From the date of revival of policy higher of 80% of premiums paid excluding any payment of taxes and extra
premiums or surrender value as available on date of death
You have Freelook Period of 15 days from the date you receive your policy document. In case you do not agree with
Do I have a right to review my
purchase? terms and conditions, you may cancel the policy where the premium you have paid will be refunded after deducting
cost of medical examination (if any) and stamp duty.
We request you to personally fill the proposal form and provide accurate information to ensure that your claim is not reduced or
declined because of non-disclosure or misrepresentation of information.
Please note:
• Aviva is not liable for any claim until receipt of premium in full, completion of underwriting and acceptance of risk.
• As per current tax laws, the premium paid towards this policy will be eligible for deduction under Section 80C of the Income Tax Act 1961. Also
the proceeds of this policy will be tax-free under Section 10(10D) of the Income Tax Act 1961. Please consult your tax advisor to confirm
eligibility for tax benefits. Tax laws are subject to change.
I confirm that I have read the Key Feature brochure and the Official Illustration of the insurance product along with this document and understand
the features such as policy benefits, premium payable including the number of years for which premium is required to be paid, lock-in period,
whether any guarantee is available and if yes then subject to what conditions.

I agree and confirm to the use of electronic medium, including email, as a mode of communication from and to the Company.

Signature of Life Assured


Signature of the Proposer
(In case different from Proposer)
Proposer name Name of Life Assured
Proposal number Proposal Date

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